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CERRITOS ENDOSCOPIC MEDICAL CENTER
NPI 1366633257
Clinic/Center - Endoscopy in Cerritos, CA

Active since August 06, 2007
11845 SOUTH ST, CERRITOS, CA 90703(562) 809-2103 Get Directions Write a Review

NPPES record last updated: June 19, 2008. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Cerritos Endoscopic Medical Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CERRITOS ENDOSCOPIC MEDICAL CENTER (NPI 1366633257) is a healthcare organization registered as an endoscopy in Cerritos, California and active in the NPI registry since August 2007. The organization lists Jaesoo Pak, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1366633257
Entity TypeOrganization
Primary Taxonomy261QE0800X
Legal Business NameJAESOO PAK, MD
Location Address11845 SOUTH STCerritos, CA 90703-6825
Mailing Address11845 South StCerritos, CA 90703-6825 · (562) 809-2103
Phone(562) 809-2103
Organization SubpartNo
Authorized OfficialJaesoo PakMedical Director · (562) 809-2103
Enumeration DateAugust 6, 2007
Last NPPES UpdateJune 19, 2008
✔ NPI 1366633257 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · EndoscopyAmbulatory Health Care Facilities
Taxonomy Code261QE0800X
License✔ Licensed in CA · 05-C0001451
Also ListedClinic/Center · Ambulatory SurgicalTaxonomy 261QA1903X
11845 SOUTH ST, Cerritos, CA 90703
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Other Names 1

Doing Business AsCerritos Endoscopic Medical Center

Other Identifiers 1

Medicare PINS051451CA

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Cerritos Endoscopic Medical Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by February 28, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateCaliforniaEnrollment IDO20120612000111Non-DME Part B · Ambulatory Surgical CenterDue dateFebruary 28, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Microscopic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43252
This procedure involves using a thin, flexible instrument called an endoscope to examine the esophagus, stomach, and upper small bowel. The endoscope has a light and camera, allowing a detailed view of these areas to help diagnose various conditions.
336 services318 patients
Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239
This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.
331 services314 patients
Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery 45384
This procedure involves using a flexible tube with a camera, called an endoscope, to view the large intestine. If any abnormal growths or polyps are found, they are removed with an electrically-heated instrument. This is a common way to prevent bowel issues.
27 services27 patients
Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385
This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.
22 services22 patients

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CERRITOS ENDOSCOPIC MEDICAL CENTER, INC.
Clinic/Center (Ambulatory Surgical)
11845 SOUTH ST
CERRITOS, CA 90703
Los Angeles County (562) 809-8082
ROMINA RAMOS CRNA
Nurse Anesthetist, Certified Registered
11845 SOUTH ST
CERRITOS, CA 90703
Los Angeles County (562) 809-8082
TEEDA M MARTOCCIA CRNA
Nurse Anesthetist, Certified Registered
11845 SOUTH ST
CERRITOS, CA 90703
Los Angeles County (562) 809-8082
MARIA T. VALMIDIANO-WILSON CRNA, MSN
Nurse Anesthetist, Certified Registered
11845 SOUTH ST
CERRITOS, CA 90703
Los Angeles County (562) 809-8082

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jaesoo Pak, MD's NPI number?

The NPI number for Jaesoo Pak, MD is 1366633257. It was assigned to this organization in the NPPES registry on August 6, 2007. The provider is doing business as Cerritos Endoscopic Medical Center.

Where is Jaesoo Pak, MD located?

Jaesoo Pak, MD is located at 11845 South St, Cerritos, CA 90703. The listed phone number is (562) 809-2103.

What is Jaesoo Pak, MD's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Endoscopy, with taxonomy code 261QE0800X.

Is Jaesoo Pak, MD enrolled in Medicare?

Yes. Jaesoo Pak, MD is registered in the Medicare PECOS enrollment system.

When is Jaesoo Pak, MD's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Ambulatory Surgical Center) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

When was this NPI record last updated?

The NPPES record for Jaesoo Pak, MD was last updated on June 19, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.